Tumor Full of 232 'Toothlets': What's an Odontoma?

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A team of oral surgeons reportedly removed 232 teeth from the
mouth of a 17-year-old boy in India on July 21. The boy was
diagnosed with a condition called complex composite odontoma, a
rare type of tumor that affects the jaw or gums, his doctors
said.

Ashik Gavai was admitted to JJ Hospital in Mumbai with swelling
in his right jaw, Dr. Sunanda Dhiware, head of the hospital's
dental department, told BBC
News.

The boy had been experiencing discomfort from the swelling for 18
months, Dhiware said. His father, Suresh Gavai, told the
Mumbai Mirror that his son began complaining of severe pain a
month ago.

In people with complex composite odontoma, a tumor grows in the
jaw and
contains tooth-like structures, as well as blobs of enamel
and dentin, the tissues that make up teeth.

"Once we opened [the tumor], little pearl-like teeth started
coming out, one-by-one," Dhiware told the BBC. "Initially, we
were collecting them, they were really like small white pearls.
But then we started to get tired. We counted 232 teeth."

However, these pearl-like objects, aren't really teeth in the
truest sense of the word, according to Dr. J. David Johnson an
associate professor at the University of Tennessee Graduate
School of Medicine and spokesperson for the American Dental
Association. [ 16
Oddest Medical Cases ]

"Some people call them 'denticals' or 'toothlets.' They're not
really true teeth because, if they were to erupt, there would be
no periodontal ligament or root structure, and they're always
deformed," Johnson said.

Although these malformed teeth don't typically cause symptoms, he
said they can lead to problems and do need to be removed, he told
Live Science.

In the case of Ashik Gavai, the toothlets did seem to be causing
some trouble, however.

"If they're growing into an area where there are nerves, that can
generate some pain. Sometimes infections will form in association
with them, and that can generate pain as well," Johnson said.

Odontomas are the most common type of odontogenic tumors,
comprising about 22 percent of all of this kind of tumor
diagnosed by dentists and
oral surgeons. Although it isn’t clear exactly why these
growths form, trauma, infection and possibly growth pressure may
be responsible, Johnson said.

After the teeth are removed surgically, the tumor isn’t likely to
return, he said. And for Gavai, now that the tumor is gone, the
28 teeth that remain in his mouth will likely be healthier.

"Typically we recommend the removal of the odontoma so it doesn’t
affect the health of the adjacent teeth or interfere with the
eruption of the other normal teeth," Johnson said.

Although Johnson said he has personally never seen an odontoma as
large as the one described in this particular case, he did not
express doubt that such a
massive tumor could form. He said that, like Gavai, most of
the patients he sees with odontomas are teenagers, with the
average age for the condition being 14. Males are slightly more
likely to develop these growths than females, he said.